6th February 2024

A 34-year-old male reports having eaten several servings of fish liver and acutely presents to the hospital with severe frontal headaches, facial flushing and nausea.

A 34-year-old male reports having eaten several servings of fish liver and acutely presents to the hospital with severe frontal headaches, facial flushing and nausea. He also experienced severe arthralgia and abdominal pain around the right upper quadrant. After 24 hours of admission, peeling of the skin on his hands, feet and perioral mucosa were noted. Angular cheilitis was noted. 

Which of the following has contributed to his clinical condition?